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Results, Part 3 Print E-mail

Providing country-level support to implement effective and sustainable human resources for health (HRH) programs


Performance Support Systems Improve Health Care Services. The Capacity Project designed and implemented a performance support process to mobilize local staff to set service delivery standards, assess health workers’ performance gaps and identify and implement interventions to improve health worker performance. The approach was used to decentralize HIV services in Belize, Costa Rica, El Salvador, Guatemala, Nicaragua and Panama and to improve health management information systems (HMIS) in Uganda. In Central America, local teams used the performance support process to improve logistics systems, acquire basic equipment, address stigma and discrimination and improve infection prevention practices. National authorities also addressed systemic issues, such as strengthening infrastructure deficiencies and addressing human resources shortages. Performance standards increased in all six countries from an average of 46% to 72%. Performance support was incorporated into existing national systems in five of the six countries. In Uganda, the approach was applied to Uganda Protestant Medical Bureau’s 258 health institutions to improve HMIS functionality and quality.

Professional Development Program Strengthens Human Resources Management Cadre. The Project collaborated with WHO/Regional Office for Africa and WHO/Geneva to design and pilot a prototype human resources management (HRM) professional development program to develop and support a critical mass of HRH champions that can tackle their organizations’ HRM problems. The program provided information to expand participants’ HRH knowledge base; blended in-class knowledge-sharing with onsite consultation, support and mentoring; built participants’ capacity to influence a broad range of stakeholders to develop strategies and take actions; developed practical solutions to HRM bottlenecks and challenges; and coached participants to develop a strategic action plan for medium-range accomplishments. The program, implemented over six months including three short workshops and on-site coaching, used the six thematic action fields of the internationally-recognized HRH Action Framework as the organizing principle. During the periods between the three workshops, participants worked on practical assignments to solve HRM problems. The intervention improved networking and partnerships; helped build an HRM cohort with a common language; provided useful tools and information; increased use of data-driven decision-making and ability to advocate for improved allocation of resources; and developed some participants’ new identities as HRH leaders.

HRIS Strengthening Activities Conducted in Botswana. In October 2008 the Project began work in Botswana, focusing on supporting the country’s immediate needs for collecting and digitizing HRH data. The Project established a regular meeting for HRIS stakeholders to discuss HRIS requirements and ensure that the information systems developed will meet long-term as well as short-term needs; employed a consultant in-country to aid in the coordination and supervision of a facility-level health workforce data collection activity, in partnership with HLSP (a consulting group) and the Ministry of Health (MOH). Project staff have also worked to engage leaders at various departments within the MOH and the Ministry of Management to coordinate the digitization of paper records.

Capacity Project Continues to Support Kenya’s Emergency Hiring Plan. Based on the hiring agreements with USAID/Kenya to involve and use the Emergency Hiring Plan mechanism to hire health workers for APHIA 2 (A2) partners, the Project worked with A2-NEP to recruit 62 new staff (data clerks, drivers, voluntary counseling and testing counselors and medical laboratory technologists) for the province. The current payroll now has 873 staff, comprised of 840 Capacity Project personnel and 33 A2 staff members.

Health Professional Associations Use Media to Achieve Goals. Professional association leaders in Kenya and Uganda are taking advantage of the Capacity Project’s training in media relations, management and leadership. In Kenya, 11 associations designed and distributed promotional brochures and launched a National Health Professional Award scheme to recognize workers’ contributions. In Uganda, four professional associations created continuing professional development guidelines, and the nursing association launched a website to improve communication within the profession. Professional association leaders in Uganda report that the Project’s communication workshops have improved the associations’ image and increased membership.

Supportive Supervision System Improves Provider Performance. The Capacity Project’s approach to supportive supervision systems included a new generation of software tools that allowed local, district and central-level teams to quickly guide targeted performance improvement plans. National HIV programs in Belize, Costa Rica, El Salvador, Guatemala, Nicaragua and Panama implemented the approach to strengthen the decentralization of HIV services to 19 hospitals. Follow-up assessments revealed improved HIV service performance across the targeted hospitals, and strengthened supervision activities at regional and national levels. In addition HR planners implemented this approach in Uganda.

Planning Tool Provides Workforce Projections in Eritrea and Rwanda. To help countries better understand health workforce issues and formulate optimal HR plans, the Capacity Project developed an HRH forecasting tool. In Eritrea and Rwanda, the Project used the tool to provide long-term workforce projections that were incorporated into the countries’ HRH strategic plans.

Enhanced Training and Software Strengthens Countries’ Use of HR Information. HRIS users in Lesotho, Namibia, Rwanda, South Africa, Southern Sudan, Swaziland, Tanzania and Uganda improved their abilities to use the software and tools. Users in Swaziland and South Africa now run their systems independently. In Uganda, two interlinked versions of iHRIS software, installed at the Ministry of Health and all health councils, allow for diverse ways to creatively and independently use the information at the national level. Data-driven decision-making workshops conducted over the last two years for mid-level planners and managers in Uganda, Swaziland and Rwanda have promoted independent use of HRIS data.

New HRIS Established in Uganda. In collaboration with the MOH, the Capacity Project established new HRIS at the Uganda Medical and Dental Practitioners Council (UMDPC), Uganda Allied Health Professions Council and Uganda Pharmacy Council (UPC). The complete database at the UPC has 326 registered pharmacists; at UMDPC the database has 4,279 registered doctors and 212 dentists. Of the registered doctors 4,164 are local while 115 are foreign. The Project also completed the establishment of the HRM database at the MOH. The database at the MOH human resources department has 8,388 individual files entered (covering MOH headquarters staff and other national-level health and research institutions [excluding national referral hospitals] and regional referral hospitals).

Capacity Project Completes Faith-Based Organization (FBO) Mapping in DR Congo, Southern Sudan and Tanzania. The Capacity Project collected and made available health assets data on FBOs. The Project also assisted FBOs in improving their data collection instruments and coordinating this mapping work to make health assets information available for national-level planning.

Professional Association Strengthens Capacity in Ukraine. The Project strengthened the management, finance and operations capacity of the Ukrainian Association of Obstetricians and Gynecologists. As a result, the association aligned its training curriculum with national standards and promoted and conducted Continuing Medical Education activities to increase members’ skills and knowledge in emergency obstetric care and family planning.

National HRH Plan Implemented in Lesotho. The Capacity Project helped to develop a process and mechanisms to ensure implementation of Lesotho’s 20-year HRH Strategic Plan, including a national workshop to foster leadership and commitment to carry out the plan.

Grants Management Policies Enhance Procedures in Mozambique. Improving efficiencies across funding sources, the Project helped to develop policies and procedures for awarding grants from Mozambique’s Global Fund to Fight AIDS, Tuberculosis and Malaria monies.

Facility Management Changed to Improve Work Climate Productivity. Based on findings from Tanzania health workforce studies, the Capacity Project and the Ministry of Health worked with facility stakeholders to select and implement facility improvement interventions that are evidence-based, inexpensive and within their power to implement. Facility in-charges received training in HR management skills and approaches, and developed action plans to address gaps in clear job expectations, client and provider rights, facility organization and community outreach. Two improvements such as keeping drugs in cupboards to prevent destruction termites, and conducting follow-up visits with clients suffering from tuberculosis and epilepsy, by riding bicycles to the patient’s homes demonstrate a stronger link between community and facility as a result of the work climate improvement intervention. Also, communities are pooling their own resources to install shelves and additional seating areas.

Productivity Improvements Continue in Zanzibar. The Capacity Project developed preliminary plans to conduct an end-line qualitative evaluation of the full set of interventions implemented in two pilot districts. In addition to gauging the impact on baseline productivity levels, it will use the evaluation to refine the interventions, document lessons learned and provide further input toward finalizing the Productivity Improvement Model.

National Curricula Integrates Family Planning into HIV Services Training in Rwanda. In Rwanda, the Capacity Project integrated family planning, safe motherhood, neonatal care and gender into the national in-service prevention of mother-to-child transmission (PMTCT) curricula and into the pre-service Registered Nursing and Midwifery Programs. To support sustained access, two master trainers were deployed in each of the country’s 30 districts and 161 on-the-job trainers in public health facilities provided training.

Feasibility Study Finds Rwandans Accept Vasectomies. An ongoing feasibility study found that no-scalpel vasectomy proved acceptable to 172 men who received the service in two district hospitals in Rwanda following a community health worker sensitization campaign and training and certification of doctors and nurses in non-scalpel vasectomy. Due to high demand, the Ministry of Health asked the Capacity Project to lead scale-up plans to increase access to vasectomy nationwide.

Data-Driven Decision-Making Workshop in Rwanda. Capacity Project staff worked with local counterparts and key HRIS stakeholders to facilitate a workshop in Rwanda on data-driven decision-making. Participants learned about data quality and presentation; discussed the need for standardization and increased data-sharing; and drafted policy and management questions. The workshop resulted in a list of next steps, including a recommendation to develop a policy on information system management for the health sector. The Project also established a working group to help mainstream HR data into regular health sector reporting mechanisms.

Capacity Project Hosts Health Awards in Kenya. The Health Awards took place in September 2008, and the Project received entries from approximately 6,000 public and private health facilities throughout Kenya for the Health Professional of the Year Award. Awards were presented for frontline activities, leadership, pioneering and professional activities. The awards aimed at promoting excellence, strengthening HRH capacity and recognizing professionalism in health care services in Kenya. The ceremony attracted extensive media coverage and was officiated by the minister of medical services.

HRIS Evaluation Conducted in Swaziland. The Capacity Project collected HRIS evaluation data in Swaziland using a standardized approach and instruments. Data from the Swaziland evaluation showed that the Project’s HRIS work has had significant impact. The Ministry of Health and Social Welfare and regional HR managers note that the system dramatically strengthens their ability to advocate for HR issues and address workforce planning, deployment, recruitment, payroll, vacancies, retirement, promotions, ghost workers, referrals, scheduling and budgeting. The system’s output reached the attention of the prime minister, who highlighted important vacancy information during the launch of the National Health Policy.

Prevention of Mother-to-Child Transmission (PMTCT) Activities Expanded in Ethiopia. The Project began supportive efforts in 72 new health center sites and transitioned 87 others, contributing to a year end total of 258 sites. The Project provided supportive supervision at all sites, on average twice per quarter. Health centers under Capacity Project support have increased testing of new antenatal care clients to over 80%. The Project provided a ten-day PMTCT training to 235 health center staff in Oromia, Tigray and Amhara regions, with a view to having five to six trained staff in all sites; 93 health center staff in Oromia and Amhara received PMTCT refresher training; eight PMTCT counselors and eight health extension workers were trained as trainers in PMTCT and on strengthening referral systems in one zone in Oromia. The Project was active in the national PMTCT technical working group, participating in the revision of the PMTCT implementation guide in preparation for an orientation and transition workshop related to the shifting of responsibility for PMTCT management from the Federal HIV/AIDS Prevention and Control Office to the Federal MOH.

Mali Matrones Study Results Disseminated. The Project disseminated the results of the study in order to increase national and international recognition and acceptance of expanding the role of matrones in preventing postpartum hemorrhaging. These results were presented to the MOH in July and to participants at the African Society of OB/GYNs in December, to favorable reviews at both. As a result, matrones at pilot project sites were authorized to continue to perform active management of the third stage of labor (AMTSL). In addition, the MOH is currently preparing an amendment to the National Service Policy Norms and Standards in order to authorize all trained matrones to practice AMTSL.

Resource Center in Southern Sudan Provides Access to Health Information. The Resource Center in Juba Teaching Hospital continues to attract staff. Since it opened in May 2008, over 1,500 staff have used it, as of July 2009. The Project employed the center manager and has increased the stock of books available. The Project oversaw the training of health workers (doctors, nurses and paramedical staff) in the use of the resource center and especially in the use of computers, including the Internet.

Leadership Development Program Completed in Tanzania. In collaboration with MSH, the Capacity Project/Tanzania completed the three-part Leadership Development Program (LDP) for 26 senior health management officers. Practical HRH strategies implemented by institutional teams yielded results in areas such as improving correct documentation on clinical investigation forms, implementing and sustaining a computerized HR database and establishing an effective and supported Council Health Service Board. Financial returns at Muhimbili National Hospital have increased as a direct result of the application of interventions triggered by skills gained from the LDP.

Most Vulnerable Children Program Launched. In Tanzania, the Project launched the Most Vulnerable Children (MVC) program. All critical staffing positions have been filled and activities are underway, directed by an approved workplan.

HIV Care Strengthened in Central America. The Project planned and implemented with universities in all six countries for the peer-to-peer voluntary counseling and testing training workshops for health-related students and subsequent testing campaigns to be organized by the students and universities. The training took place from January to March 2009.


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